The question some people might be asking themselves: "What is Single Payer?" Single-Payer is exactly what it's name implies. This system will enable one government agency to collect the money for health care expenses, and then dispense it to physicians and hospitals for the health care costs of the citizens. No deductibles, no co-pays, no out of pocket expenses at all. So why is this such a hot issue right now? As our elected leaders in Washington begin work on reforming our nation's health care system that leaves over 45 million Americans uninsured, and a considerable amount more that are under-insured, the health insurance and pharmaceutical industries have swung into action. These companies know that a single payer system will put them out of business (the insurance companies) and reduce their monopolies on profit (the pharmaceutical companies).
It all comes down to the basic economics of a free market system. Insurance companies are a business. Their primary objective is to turn a profit. They are able to accomplish this by denying care to the consumer. Another way these companies are able to maximize their profits is through the use of "The Network." The way the network functions is really quite simple. The insurance company signs a contract with a health care provider. That provider than becomes "in network" which means the insurance company receives a discount when that provider bills for their services. This doesn't sound too bad, the insurance company gets a reduced rate for services, and the provider is "garunteed" some payment for the services they perform; but there's a catch. The patient's that have insurance through that insurance company are told by the insurer which doctors they are allowed to see, meaning they are only allowed to see doctors that are in the network, eliminating patient choice of physician. They even go as far to say that if the patient chooses to see a physician that is not in the network, they will be responsible for the entire bill. From the physician stand point, they have a win-lose situation. By joining the network, they are ensuring that they will continue to have patient's to see (after all, everyone needs to make a living). However, the physician is then bound by that contract to seek reimbursement from the insurance company only and to accept the contracted discount. The insurance company then uses it's large staff to pick through claims and deny them for any number of reasons. In some cases, they will be denied just for the sake of holding off payment. The provider then has to employ more people to work on insurance follow up and appeals. The claims could also be denied because the provider failed to get a prior authorization from the insurance company to perform the service, or because the diagnosis the provider used was determined to be a pre-existing condition. In some of these cases, the provider has to then discount the service to 0 and receive no reimbursement for their hard work, and in other cases, the patient will receive the full amount of the bill.
Let's take a short look at the repercussions when a patient receives a bill for their medical services. If a patient is uninsured, the provider will sometimes need to discount the cost of the medical procedures by up to 80% just to receive some payment, and in some cases 100% of the bill will be discounted. Don't think that patient just received free care however. As often as this situation occurs, especially in today's economic world where health care costs are sky rocketing which means increased deductibles, co-pays, co-insurance, and other out of pocket expenses, including employer premiums, the number of people uninsured is growing. Employers are finding themselves unable to provide coverage for their employees, and the doctors have no choice but to increase their fees in order to level out the balance sheets from all of the services that they don't receive reimbursement for.
So how would single payer fix this problem? By eliminating for profit insurance companies, single payer would gauruntee affordable coverage for everyone. This coverage would stay in effect even if you lost your job, had a 'pre-existing' condition, or developed a severe illness. Single payer would cover all medically necessary services including preventive care, vision care, dental care, hospital and primary care, as well as emergency services. This would be accomplished by eliminating the wasteful spending that takes place in our current employer based, for profit system through private insurers. How wasteful is the spending? On average, the private insurance industry operates with a 30% overhead. This means that 30 cents of every health care dollar goes to pay employees, administrative costs, and profits. Medicare is an example of a single payer system that operates at roughly a 3% overhead.
So how are these companies doing with their profits during this tough economic time? Here are some statistics from the Daily Kos showing what the CEO's of some of these insurance companies brought home in 2008:
- Aetna CEO Ron Williams - $24,300,112.00
- Cigna CEO H. Edward Hanway - $12,236,740.00
- Humana CEO Michael McCallister - $4,764,309.00
- HealthNet CEO Jay Gellert - $4,425,355.00
- United Health Group CEO Stephen Hemsley - $3,241,042.00
There's nothing wrong with having a free market, but it should not be allowed to exist in an industry that literally has people's lives in their hands. Put your health care back in the exam room between you and your physician, not in the office of a CEO with no medical training. Support Single Payer.
No comments:
Post a Comment